Anti-inflammatory cytokine response and the development of multiple organ failure in severe sepsis
Anti-inflammatory cytokine response and the development of multiple organ failure in severe sepsis
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DOI：
10.1034/j.1399-6576.2003.00004.x
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发表时间：
2003-03-01
影响因子：
2.1
通讯作者：
Kaukinen, S
中科院分区：
文献类型：
--
作者：
Loisa, P;Rinne, T;Kaukinen, S
背景：脓毒症中促炎细胞因子的产生激活全身炎症反应。患者还产生代偿性抗炎反应，这可能对过度活跃的炎症具有重要的下调作用。然而，这种抗炎反应在脓毒症中的作用尚未完全阐明。在这项前瞻性研究中，我们调查了严重脓毒症的促炎和抗炎细胞因子的配置文件之间的关系，并在多器官功能衰竭（MOF.Methods）的发展中的作用：38例符合严重脓毒症的标准进行了研究。MOF定义为最大SOFA评分为10或更高。使用促炎性IL-6和IL-1 β以及抗炎性IL-10和IL-1 ra的系列测量。在脓毒症发作时和ICU期间的第3和第5天采集细胞因子样本。结果：在有或无MOF的患者中，初始IL-10和IL-1 ra反应是相同的。在MOF患者中抗炎细胞因子水平保持升高，而在没有MOF的患者中水平下降。IL-6/IL-10比值在第1天和第3天在MOF患者中显著高于无MOF的患者。结论：我们不能证明MOF患者中抗炎性IL-10的过度产生。相反，高IL-6/IL-10比值表明IL-10缺乏可能有助于严重脓毒症中MOF的发展。
Background: The production of proinflammatory cytokines activates the systemic inflammatory response in sepsis. Patients also develop a compensatory anti-inflammatory reaction, which may have an important down-regulatory effect on the overactive inflammation. However, the role of this anti-inflammatory response in sepsis is not completely clarified. In this prospective study, we investigated the relationship between the pro- and anti-inflammatory cytokine profiles in severe sepsis and their role in the development of multiple organ failure (MOF).Methods: Thirty-eight patients meeting the criteria for severe sepsis were studied. MOF was defined as a maximum SOFA score of 10 or higher. Serial measurements of the proinflammatory IL-6 and IL-1beta and the anti-inflammatory IL-10 and IL-1ra were used. The cytokine samples were taken at the onset of sepsis and on the third and fifth day during the ICU period.Results: The initial IL-10 and IL-1ra responses were identical in patients with or without MOF. The anti-inflammatory cytokine levels remained elevated in the MOF patients, whereas in patients without MOF the levels declined. The IL-6/IL-10 ratio was significantly higher in the MOF patients on days 1 and 3 compared with patients without MOF.Conclusions: We could not demonstrate overproduction of anti-inflammatory IL-10 in MOF patients. On the contrary, the high IL-6/IL-10 ratio indicates that IL-10 deficiency may contribute to the development of MOF in severe sepsis.